Employers who tell workers suffering from job-related injuries to return to work as soon as possible may seem a bit harsh. Yet, some disability and workers' compensation experts argue that in some cases, a tough love approach may be doing workers a favor.

A grass-roots initiative called the 60 Summits Project is promoting guidelines to prevent workplace disabilities and improve the return-to-work process. The American College of Occupational and Environmental Medicine developed the guidelines, which first appeared in a 2006 white paper, "Preventing Needless Work Disability by Helping People Stay Employed."

The ACOEM guidelines state, in part, employers and physicians should stop assuming that absence from work is medically required and that treatment can reduce disability.

Moreover, parties invested in the disability and workers' compensation space need to "pay attention to the non-medical causes that underlie discretionary and unnecessary disability," the guidelines explain.

Thus far, research shows most workers injured on the job are able to stay at work or return to work after a brief recovery period. However, according to ACOEM, "10% of these workers incur significant work absences and/or life disruptions that can lead to prolonged or permanent withdrawal from workplace."

Jennifer Christian chaired the group of physicians who helped developed the guidelines and is founder of 60 Summits Project, which consists of employers and health care providers. "There are a surprising number who have medical conditions that normally would cause only a few days of work absence - common problems like sprains and strains of the lower back, neck, shoulder, knee and wrist, or depression and anxiety," she says.

New paradigm for workplace disability

The group offers recommendations on improving workplace disability programs and reducing life disruptions created by illness and injuries. For example, they discuss adopting a disability prevention model, addressing behavioral and circumstantial realities that create and prolong work disability, and understanding the powerful contribution that motivation and incentives make to outcomes.

The return-to-work process starts when an employee becomes injured or ill and his or her job duties are altered. Physicians typically determine when and how that employee returns to work, and some say therein may lie the problem.

"Physicians know that much disability [leave] is not required from a strictly medical point of view," Christian asserts. "We see devastating psychological, medical, social and economic effects caused by unnecessarily prolonged work disability and loss of employability."

Among 60 Summits supporters, the project recently picked up a major backer in Prudential Financial, which signed on as the project's first charter North American sponsor.

"Each year, costs of disability benefits exceed a staggering $100 billion, resulting in an enormous impact on the North American economy," says Dr. Robert MacBride, medical director at Prudential Financial. "ACOEM's guidelines emphasize a distinct opportunity for legislators, business and medical professionals to help prevent wasted human and financial resources and stem productivity losses."

Recovery at work

Employers need to understand that they need to control return-to-work decisions, says Kathy Diaz, fund administrator at the Food Industry Self Insurance Fund of New Mexico, a nonprofit group providing self-coverage in worker's compensation for the grocery, restaurant, farming and hospitality industries. "Asking a worker to go back to work is not a bad faith effort," she affirms.

Diaz's organization is promoting the ACOEM guidelines among its members. The group covers about 8% of workers in the state and has $10 million in annual premiums. Diaz, a former special education instructor, has more than 15 years of experience in the workers' compensation arena.

"In special education, we tried to minimize disability all of the time because that's what people wanted us to do. Yet in workers compensation, I felt like people were asking us to maximize their disabilities to get benefits," she says. "It struck me that returning people back to work was an important issue, but I did not hear people around me saying so."

She attended a conference in New Mexico on workers' compensation where Christian spoke about the ACOEM guidelines and the 60 Summits Project. Afterward, she felt validated and inspired.

For the most part, employers are clueless about the benefits of the return-to-work process and are fearful about harming employees or incurring further costs by bringing employees back to work, Diaz says. With the material from the 60 Summits Project, Diaz's organization has been able to educate its members about the benefits and financial rewards of a recovery-at-work program.

Employers sometimes think modified duties include "putting a worker behind a desk with their feet up in the air and the person is not required to move," she says. "Of course, it all depends on the injury. It is not always about sedentary work. It may just mean the worker has to rest every hour for five minutes."

Convincing physicians of recovery-at-work is a challenge as well, Diaz says. She believes that having ACOEM guidelines coming from doctors was important.

"There are statistics showing that injured workers healing rates are quicker and that there are fewer disruptions in their lives if you allow them to return to work. The challenge is getting through to doctors, who after all, have to write the releases. If doctors say the person will benefit from a few days off, then that is what [the person] will do," she explains.

"The message from 60 Summits that has been most powerful for us is that doctors can hear from colleagues that they are doing more service to an injured worker by having them to return to work than giving them a few days off."